We're all in a holding pattern, waiting and waiting for HHS to vet the HITECH "meaningful use" guidelines. No one wants to forage ahead without a compass. But if you put off your plans any longer, you could miss out on incentive funding this year. Conversions take time; we're already in March.

How quickly can you implement an EHR solution? It's hard to say. Some conversions take as little as six months, some as long as two years. To qualify for 2009 HITECH funding, your system must be up and running by November at the latest. Mark Seavitt, chairman of the Certification Commission for Healthcare Information Technology, recommended immediate action at the annual AHIMA conference in October- over five months ago. The clock is ticking!

Can you do anything to speed up the process? Perhaps. A lot will depend on the vendor or product you choose, but there are other factors. Staff readiness and availability, your hardware infrastructure, training resources, how you plan, and what you expect will affect your outcome. There are at least two keys to success: assigning talented, dedicated people to the task, and maintaining a positive attitude. If you're upbeat about the new system, your enthusiasm will trickle down to your staff; if morale becomes low, the project is doomed (see this invaluable planning guide from the AAFP for more information and advice). But even if you do everything right- buy the best product, hire brilliant technicians, implement everything seamlessly- your conversion could take many, many months. Rush the job and you may wind up saddled with an expensive, buggy system no one in your office wants to use.

How likely is it that the EHR product you buy today will meet the guidelines when they're announced tomorrow? Extremely likely. The IT sector has spent decades preparing for the digitization of health records. They've anticipated anything and everything the government could ask for. Chances are your EHR system will be capable of much more than the minimum required by HITECH.

So why wait? You know where health records are headed; you want to be in compliance, compatible with other providers and on the cutting edge of the health IT revolution. Choose an EHR wisely, and choose it soon!

February 21st is the last day you can apply for 2009 Physician Quality Reporting Initiative (PQRI) funding. PQRI awards a bonus equal to 2% of the total amount you billed to Medicare/Medicaid in the given year. If you're a health care provider you are almost certainly eligible for this money. Don't let the window lapse! It’s not too late. An average GP can compile a PQRI report in a few hours. Electronic Heath Record (EHR) system users can do it even faster.

The concept, at least, is simple:

PQRI applies to services billed under a certain set of CMS claim codes. You create a report based on the eligible claim codes you used during the year. PQRI dictates how frequently each claim code can appear on the report: codes linked to periodic care for chronic conditions, like diabetes mellitus, can be reported perhaps only once per year per patient, whereas codes linked to specific care for acute conditions, like heart attack or stroke, can be reported as many times as you used them. Once you have the report, you assess whether or not you met the PQRI care requirements associated with each claim code on your report. Your rating will be a ratio of the all requirements you met to all the claim codes you listed.

Easy, right? Much more so when a computer does it for you. EHRs have awesome reporting capabilities; as EHRs increase in strength and prevalence, quality assessment practices of every stripe will become standard throughout the industry. So cash in while incentives are still being offered!

Click here for step-by-step instructions on how to apply for 2009 PQRI funding. The CMS PQRI portal has additional information and resources, including a toolkit. The AMA also has a resource page and toolkit.

If you're not sure you can pull a 2009 PQRI report out of your hat by yourself, consider consulting an EHR technician- even if you're not currently using an EHR. Many EHR providers are offering PQRI-related support. There are also services available online, for a fee. If you think you'll qualify for a large bonus, hiring a consultant might be worth the expense.

Act quickly. You've already earned it- go ahead and claim it! If not for 2009, think ahead to 2010. Failing to participate in PQRI might disqualify you for other forms of funding (it will almost certainly be a prerequisite for participation in the ARRA program rewarding the “meaningful use” of EHRs, for instance). Don't miss out. Start the process today!

A few years ago, anticipating changes in the wake of new federal requirements, several major players entered the Personal Health Record (PHR) arena, notably Google and Revolution Health (founded by Steve Case, co-founder of AOL). Well, today we learn the Revolution Health application is folding…while Google continues to grapple with public relations after media reports linking use of their application to medical errors.

These applications were targeted directly to patients, not health care providers. Patients are a.) entrenched in the current system, having never before been asked to maintain their own records, b.) not knowledgeable about medical data and how to interpret it, and c.) largely wary of technology. Those who aren’t wary may be cynical about the compatibility of PHR data between providers. It’s hardly surprising they’ve been slow to adopt, given the absence of institutional support.

So the initial ventures appear to be faltering…but don’t be deceived. We are hurtling towards a PHR-based records model. As more providers meet the national Electronic Health Record (EHR) conversion deadline, the PHR model will make the most logistical sense. It makes common sense as well. Think about it: Americans move on average every six years. They traverse a field littered with specialists and urgent care facilities. The only common denominator in the health history of a modern patient is the patient him/herself.

To wit, the Department of Health and Human Services (HHS) aggressively promotes PHRs among Medicare/Medicaid clients. Patient advocates have never stopped beating the drum. The question is not whether, but when and how PHRs will catch fire.

It might pay you to be ahead of the curve. As time and testing have repeatedly established: electronic records save money. A patient with a PHR costs $0 in administrative overhead. You won’t have to pay your staff to chase down hospital lab results or spend time on the phone with insurance companies. Plug it in, press a button and everything will be right in front of you. Press another button and send it to any other provider or pharmacy anywhere, instantly.

If that doesn’t sway you: the government is sweetening the deal. HHS will distribute billions of dollars this year in stimulus funding to health care providers who put EHR systems to what they call “meaningful use”. Last week the officer in charge of the program, Joshua Seidman, confirmed integrating PHRs into your system can help you qualify.

Steven Schiff, a California cardiologist, posted in favor of PHRs at the Huffington Post yesterday. A longtime user of EHR technology, he dispels a common concern about the future of progress notes…well worth a look.

For a more wonkish and thorough evaluation of the value of PHRs, you can download the Center for Information Technology Leadership (CiTL) PHR research report.

February 2010 is almost here, and implementation for the HITECH legislation is moving ahead on schedule. For those unaware, the HITECH Act is designed to promote the adoption of electronic health records (EHRs) by reimbursing physicians who purchase and use qualified EHR systems. Physicians with enough Medicare patients can receive up to $44,000, and physicians who see at least 30% Medicaid patients will qualify for $64,000. Meaningful Use is a set of standards physicians and EHR vendors must meet in order to qualify.

The Meaningful Use Interim Final Rule (IFR) and the Notice of Proposed Rulemaking (NPRM) is still within the public comment period, which lasts until March 15th. According to David Blumenthal, National Coordinator for Health Information Technology, the NPRM is “not a done deal.” The National Coordinator promises to entertain all comments “within the scope of the regulation.” The government won’t be able to add anything else to the rule, but may modify or remove existing aspects.

The Meaningful Use IFR will be much more difficult to change, according to Jodi Daniel, ONC’s director of the Office of Policy and Research. This is good because many EHR vendors are working to ensure their systems will meet the requirements. She said the office is still accepting comments, however, and expects some small changes.

Some groups view the meaningful use IFR requirements as “too high and too many.” Catholic Healthcare West, Intermountain Healthcare, and Kaiser Permanente have all adopted EHRs, but there are gaps between the systems’ features and meaningful use requirements. The groups are critical of the “all or nothing” approach taken by the legislation. In this case, the advantage lies with practices who do currently have an EHR system. They can purchase a system that will meet their needs and the meaningful use requirements right out of the box. Existing EHR users may face expensive upgrades.

Certification for meaningful use is also moving forward. CCHIT has discontinued their “preliminary” meaningful use certification and replaced it with an updated “meaningful use stage 1” comprehensive and modular certification. Although CCHIT has long been the most well-known certification agency, the National Institute of Standards and Technology (NIST) awarded consulting group Booz Allen Hamilton, Inc, a contract to develop a testing method and process for certifying EHRs. No one is sure which organization will actually issue certifications. According to Blumenthal, ONC will review the final legislation and see where CCHIT “fits in.” He states that CCHIT will “clearly have the option to participate in certification going forward,” but no one is sure exactly what that role will be.

Physicians need to get started with their EHR purchase post haste to qualify for the first year of reimbursements in 2011. Implementation of any EHR system usually takes a couple of months. In addition, many vendors are currently backlogged with installations. Contact your health IT consultant today to see how you can qualify.

The HITECH Stimulus Act is legislation designed to promote the adoption of Electronic Health Records (EHRs) among physicians. Passed near the beginning of 2009, the HITECH Act will reimburse qualified physicians who purchase and implement a certified EHR system. If a physician’s practice includes 30% Medicaid patients or more, they could qualify for up to $64,000. Medicare incentives could total up to $44,000, depending upon allowable charges.

“Meaningful Use” is a core concept of the HITECH Stimulus Act. Physicians must do more than simply seeing a certain amount of Medicaid or Medicare patients. “Meaningful Use” outlines a set of EHR features that physicians must use in their practice. On December 30th, 2009, The Centers for Medicare and Medicaid Services (CMS) along with the Office of the National Coordinator for Health Information Technology (ONC) published a final recommendation for the meaningful use definition.

Meaningful use is broken up into several stages. In Stage 1, physicians will have to use features like Computerized Physician Order Entry (CPOE), implement drug-to-drug, drug-to-allergy, and drug-to-forumlary checks, and maintain an updated problem list with ICD-9 or SNOMED, along with a whole host of other requirements. For the most part, the final recommendations look much the same as the initial recommendations from the ONC committee earlier in 2009. The final recommendations will take effect in approximately thirty days; the public is encouraged to comment for the next sixty days. CMS could decide to change the recommendations before final adoption, but most think any changes will be minor.

Deliberations over the meaningful use definitions created a great deal of uncertainty in the EHR market. Most physicians put their buying plans on hold, rather than taking the chance of purchasing an EHR that may not meet the requirements. While caution is understandable, physicians who wait too long may have trouble implementing an EHR in time to qualify for the 2011 reimbursements.

Purchasing an EHR is not like buying off-the-shelf software. With all the vendors, systems, and options, it normally takes several months to make a purchase decision. Once they sign papers, physicians may need to wait up to six months for installation to begin because of vendor backlogs. After installation, physicians and their staff still have to train, which can take weeks for more complicated systems.

Fortunately, the wait is over. CMS and ONC have published their final recommendations. EHR vendors are busy making sure their systems meet the meaningful use requirements. Likewise, physicians need to get busy with their EHR search. Physicians need to make a decision as soon as possible to qualify for 2011 and avoid increasing vendor backlogs. If you are interested in participating in the HITECH Stimulus, ask an EHR vendor to perform a needs analysis for your practice.